How do Saxenda (Liraglutide) and Liraglutide compare to Wegovy (Semaglutide) in terms of instructions and efficacy for weight management?

Comparison of Saxenda (Liraglutide) and Wegovy (Semaglutide) for Weight Management

Wegovy (semaglutide) is significantly more effective than Saxenda (liraglutide) for weight loss, with semaglutide 2.4mg producing approximately 15% weight loss compared to 5-8% with liraglutide 3.0mg. 1, 2

Mechanism of Action

• Both medications are GLP-1 receptor agonists that work by suppressing appetite, delaying gastric emptying, and increasing satiety 3
• Liraglutide (Saxenda) has 97% homology to human GLP-1 3
• Both medications act on the hypothalamus to control appetite and food intake 3, 2

Efficacy Comparison

• Semaglutide (Wegovy) demonstrates superior weight loss efficacy:

  • Mean weight loss of 14.9-16.0% at 68 weeks 2
  • 70.9% of patients achieve ≥10% weight loss 1
  • 55.6% of patients achieve ≥15% weight loss 1
  • 38.5% of patients achieve ≥20% weight loss 1

• Liraglutide (Saxenda) shows moderate weight loss efficacy:

  • Mean weight loss of 5.4-8.0% at 56 weeks 3, 2
  • 25.6% of patients achieve ≥10% weight loss 1
  • 12.0% of patients achieve ≥15% weight loss 1
  • 6.0% of patients achieve ≥20% weight loss 1

• Direct comparison in the STEP 8 trial showed semaglutide 2.4mg produced 9.4% greater weight loss than liraglutide 3.0mg (15.8% vs 6.4%) 1

Administration Instructions

Saxenda (Liraglutide 3.0mg)

• Administered as a once-daily subcutaneous injection 2
• Dosing schedule:
  • Start at 0.6 mg daily for 1 week 3
  • Increase by 0.6 mg weekly (0.6→1.2→1.8→2.4→3.0 mg) 3, 2
  • Target maintenance dose: 3.0 mg daily 2
  • Full dose escalation takes 4 weeks to complete 2
• If more than 2 consecutive doses are missed, clinical judgment is required for subsequent dosing 2

Wegovy (Semaglutide 2.4mg)

• Administered as a once-weekly subcutaneous injection 2
• Dosing schedule:
  • Start at 0.25 mg weekly for 4 weeks 2
  • Increase to 0.5 mg weekly for 4 weeks 2
  • Increase to 1.0 mg weekly for 4 weeks 2
  • Increase to 1.7 mg weekly for 4 weeks 2
  • Target maintenance dose: 2.4 mg weekly 2
  • Full dose escalation takes 16 weeks to complete 2

Side Effects and Safety

• Both medications share similar adverse effect profiles, primarily gastrointestinal symptoms 3, 1

• Common side effects for both medications:

  • Nausea (most common) 3, 1
  • Vomiting 3
  • Diarrhea 2
  • Constipation 2
  • Headache 3

• Gastrointestinal adverse events:

  • Semaglutide: reported in 84.1% of patients 1
  • Liraglutide: reported in 82.7% of patients 1

• Treatment discontinuation rates:

  • Semaglutide: 13.5% of patients 1
  • Liraglutide: 27.6% of patients 1

Indications and Patient Selection

• Both medications are indicated for:

  • Patients with BMI ≥30 kg/m² (obesity) 2, 3
  • Patients with BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, dyslipidemia, type 2 diabetes, or obstructive sleep apnea) 2, 3

• Both should be used as adjuncts to reduced-calorie diet and increased physical activity 3

• Consider discontinuing if <5% weight loss is achieved after 12 weeks on the maintenance dose 2

Clinical Considerations

• Gradual dose titration is essential for both medications to minimize gastrointestinal side effects 2
• Both medications require long-term use to maintain weight loss benefits 2
• Both medications have shown cardiovascular benefits in clinical trials 4
• Patients with type 2 diabetes may particularly benefit from these medications due to their glucose-lowering effects 2

Practical Differences

• Semaglutide offers the convenience of once-weekly dosing compared to daily dosing with liraglutide 2, 3
• Semaglutide has a longer dose escalation period (16 weeks vs 4 weeks) 2
• Semaglutide produces substantially greater weight loss but with similar side effect profiles 1, 5

In conclusion, while both medications are effective for weight management, Wegovy (semaglutide) demonstrates significantly superior efficacy with comparable tolerability to Saxenda (liraglutide), making it the preferred option when available and affordable 1, 5.